Additional file 2: Cost analysis SOC versus VSI – Medial meniscal diagnosis, therapy and surgery

Diagnosis and treatment for medial meniscal tear [knee] - ICD9CM Diagnosis code 836.0
Standard of Care versus VSI diagnosis and treatment paradigm - costs using 2013 reimbursement data
Number of diag. & ther. procedures performed for ICD9CM Diagnosis code 836.0 = / 540,803 / derived from positive findings (TP and FP)
Number of diagnostic procedures performed for ICD9CM Diagnosis code 836.0 = / 431,523 / derived from negative findings (FN and TN)
Procedure code / Description / SOC Cost / Notes / VSI Cost / Notes
CPT 99203 / Evaluation and management - new patient - 30 minutes / $108.19 / $108.19
CPT 73560 / Xray 1-2 views / $32.32 / $32.32
CPT 73721 / Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; without contrast material, non-facility (RVUs of 11.91) (Global) / $405.21 / $0.00
CPT 73721-26 / Magnetic resonance (e.g., proton) imaging, any joint of lower extremity; without contrast material, non-facility (RVUs of 1.96) (Professional component "-26") / $66.69 / $0.00
CPT 20610 / Arthrocentesis - aspiration or injection major joint or bursa @ 10% of time for diagnosis (1) / $65.56 / $0.00
CPT 29870 / Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) - nonfacility setting / $0.00 / $603.23
CPT 29877 / Arthroscopy, knee surgical; chondroplasty – debridement or shaving of articular cartilage [for TP findings] / $632.49 / $632.49
CPT 29881 / Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed [for FP and FN CO findings] / $551.51 / $551.51
CPT 01440 / General anesthesia @ 45 minutes / $131.55 / $131.55
APC 0041 / Hospital outpatient - knee arthroscopy/surgery / $2,111.62 / $2,111.62
CPT 99213 / Evaluation and management - existing patient - 30 minutes / $72.81 / $72.81
Total cost per patient (for true positive findings) / $3,567.44 / $3,692.21
Total cost per patient (for false negative findings) / $3.486.46 / $0
Total cost per patient (for neg findings) [diagnostic procedures only) / $618.97 / $743.74
Number of surgical procedures performed based on TP diagnostic findings = / 450,172 / (TP ) / 450,172 / (TP)
Number of surgical procedures performed based on FP diagnostic findings = / 90,631 / (FP) / 0 / (FP)
Number of surgical procedures performed based on FN MRI findings = / 0 / 42,518 / (FN)
Number of people who are medically managed (e.g. PT) due to FN MRI findings= / 42,518 / (FN) / 0
Number of diag procedures performed based on MRI neg findings = / 431,523 / (FN+TN) / 479,636 / (FP+TN)
Total cost to system for diag and treatment of all positives that should be pos = / $1,605,959,799 / (TP ) / $1,819,114,945 / (TP + FN)
Total cost to system for diagnosis and treatment FP = / $315,979,903 / (FP) / $0
Total cost to system for diagnosis = / $267,098,065 / (FN+TN) / $356,724,479 / (FP+TN)
Cost per patient for medical management [PT](10.3 sessions over 10 wks) = / $1,318 / $1,318
Number FN patients who have insurance (@85% of FN) = / 42,518 / (FN) / 0 / (FN)
Total costs to system for medical mgmt (physical therapy) of FN findings on MRI = / $56,020,696 / (FN) / $0
Percent of patients under medical mgmt crossing over to surgery(2) / 30% / 0%
Number of patients who crossed over (CO) to surgery in FN group = / 12,755 / (FN CO) / 0
Cost of FN medical mgmt patients crossing over to surgery = / $37,608,914 / $0
Number of patients who underwent phys ther post surgical arthroscopy (@85%) = / 470,524 / (TP+FP+FN CO) / 418,787 / (FN+TP)
Costs for patients under physical therapy post surgery for TP, FP, and FN CO results = / $619,951,623 / (TP+FP+FN CO) / $551,783,042 / (FN+TP)
Total costs diagnosis and treatment (all positive and negative findings)= / $2,902,619,000 / $2,727,622,465
Cost per patient diagnosis & treatment / $2,985 / $2,805
Complications from arthroscopy procedures / Incidence / Cost/event / Incidence / Cost/event
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041] / 0.30% / $2,633.53 / 0.010% / $2,633.53
Venous thromboembolism (VTE) [includes 12 month for treatment] / 0.19% / $14,865.00 / 0.127% / $14,865.00
Deep vein thrombosis (DVT) [includes 12 month for treatment] / 0.12% / $14,865.00 / 0.080% / $14,865.00
Pulmonary embolism (PE) [includes 12 month for treatment] / 0.08% / $22,900.00 / 0.053% / $22,900.00
Number of arthro procedures which complications were applied to = / 553,558 / 1,465,016
Occurrence of complications based on incidence and number of procedures
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041] / 1,661 / 147
Venous thromboembolism (VTE) / 1,052 / 1,860
Deep vein thrombosis (DVT) / 664 / 1,175
Pulmonary embolism / 443 / 783
Overall costs for complications
Reoperation (any reason) [includes costs of CPT 29871 & APC 0041] = / $4,373,435 / $385,816
Venous thromboembolism (VTE) = / $15,634,418 / $27,646,230
Deep vein thrombosis (DVT) = / $9,874,369 / $17,460,777
Pulmonary embolism = / $10,141,184 / $17,923,584
Total costs complications = / $40,023,407 / $63,425,408
Cost complications per patient for those exposed to arthroscopy = / $72 / $43
Overall costs – diagnosis, therapy, and complications
Total costs - diagnosis, therapeutics, and complications / $2,942,642,408 / $2,792,094,053
Cost differential complications (which costs more and by how much) = / $150,548,355
Overall cost per patient = / $3,026 / $2,871
Cost differential per patient (which costs more and by how much) = / $155
Footnotes:
(1) National Ambulatory Medical Care Survey data 2010 - 10% figure based on 2010 figures for arthrocentesis for meniscal knee injury (100,000/970,000= 10%)
(2) Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthrtitis. New England Journal Medicine 2013; DOI: 10.1056/NEJMoa1301408

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